The two midnight rule affects both outpatient/observation and inpatient status. It is designed to limit the use of observation status for Medicare patients, which results in higher out-of-pocket costs for Medicare beneficiaries. The 2014 Inpatient Prospective Payment System (IPPS) final rule, published August 2, 2013, established new requirements for coverage of Medicare Part A inpatient … [Read More]

On February 12, 2014, the Centers for Medicare and Medicaid (CMS) published MLN Matters Article # MM8525 regarding the revised National Coverage Determination (NCD) on single chamber and dual chamber permanent cardiac pacemakers. This NCD, 20.8.3, concludes that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of … [Read More]

Correct coding of sepsis or septicemia continues to be an area of concern for coders and a target of RAC. Whenever there is a question about sepsis, or any diagnosis, we are instructed to go back to the Official Guidelines for Coding and Reporting along with further guidance from Coding Clinic. Diagnosis: First, does the … [Read More]

The American healthcare industry is going through an unprecedented transformation. The current fee-for-service model, historically focused on disease management, is rapidly evolving to an outcome-based system. All healthcare constituents, whether a physician practice, hospital, lab, nursing facility, or a payer, are currently designed to support a patient interaction or a visit. The massive change from … [Read More]

By Jack Duffy Executive Vice President For a number of years hospital-based clinics have played a significant role in the business operations of many hospitals. They played a key role in care coordination for complex services like infusion therapies, and allowed physicians more hours to remain productive on the hospital campus. The clinics also served … [Read More]